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HomeMy WebLinkAboutThe Old Town Farm LLC ?j RECEIVED JUL - 1 2022 Southold Town Clerk APPLICATION FOR A PERMIT TO HOLD A SPECIAL EVENT Please provide ALL ofthe information requested below.Incomplete applications WILL NOT be reviewed. Ed w, lvd ba r s d bcL- Special Event Permit# Applicant(s)name: Q i d Ty h1 Date of Submission Name of Event SCTM#'s 1000-Section Black ' Lot(s) Dates of Each Event: �VA W V ��3 t If Multiple Dates are requested,applicant must give all information for all dates. Nature of Event: PK I V �.Q 1. (Please attach a detailed descrip on of EACH eveff to this application) Time Period(Hours)of Event: From E to awl Y Town Services requested: ( )Yes (*Sf7 No If yes,Describe Police Dept._Highway Dept. `Describe Services Maximum Number of Persons Attending At One Time: ber of cars expected 41 Is a Tent or other temporary structure being used? )r]Yes [ ]No If yes provide size(s) Will food be served? $Yes [ ]No If yes provide number and name(s)of food vendor(s) Updated 8/7/2018 (( CZALf 1141 Ct-V4 r r Suffolk County permit#(s) Will other vendors be on the premises during the event?[ ]Yes [ ]No If yes how many? Describe Type of vendor(s) IIPA"r o �^ P.,� 1nn j2A Property Owner(name/address): �( t�Gl1�� �a� Contact Person and Contact Tel.# r&,?>1 e-mail address Q44-s 0 +hp t l Flow Event Location:Street-Hamlet Address: :2?6 S7-1!�- SC Mailing Address to Send Event Permit to: S � Have any of the development rights been spidp the Town of Southold[ ]Yes No and/or Suffolk County Agricultural Program? '[ ]Yes No If yes to either or both also 'indicate on the attached plan the boundaries of the reserve ea.upon which the event will take place. YOU WWSTATYACH A-PARKINGIEV.EN_T__PLANTO THISAPPLICATION_IF_THE EXPECTED ATTENDANCE IS 300 OR MORE PEOPLE,YOU MUST ALSO ATTACH A TRAFFIC CONTROL PLAN(see next page) A Parking/Event Plan may be a survey, site plan and/or aerial view (for example Google Earth) of the subject property.INDICATE ON THE PLAN ALL of the following information: A parking/event plan showing: (1) The size of the property and its location in relation to abutting streets or highways. (2) The size and location of any existing building(s)or structure(s)that will be in operation during the course of the event and any proposed building,structure,or signs to be erected temporarily for the event. (3) The location of the stage or tents,if any. (4) The designated areas of use for spectators, exhibitors,vendors,employees and organizers. (5) Location of all entries and exits. (6) The location of all fire extinguishers and other fire safety equipment. (7) The location of all temporary utilities to be installed for the event,if any. (8) The layout of any parking area€or-automobiles and other vehicles and the means of ingress and egress for such parking areas. The parking spaces must allow for 300 sq. ft. per car. (9) A traffic control plan for vehiclesentering and leaping thesite for the proposed event. (10) Plan for the use of live outdoor music,loudspeakers and other sounds which will be used, if any,and the type and location of speakers and other audio equipment. (11) A description of emergency access and facilities related to the event. (12) Provisions to dispose of any garbage,trash,rubbish or other refuse. (13) Location and description of any additional lighting to be utilized in conjunction with the event. Updated 8/7/2018 (14) Location of sanitary facilities on site. Traffic Control Plan Events for three hundred(300)or more people also require submission and approval of a traffic control plan,acceptable to the Town of Southold,AND a qualified traffic controller must be provided.Please attached a written description and/or notate on the parking event plan the following:1)Who will be conducting traffic,2)Where they will be stationed on site,3)How they will direct the entrance, circulation,parking,and exiting of cars on site,and 4)Contact information for use by Southold Town Police-. OWNER'S SIGNATURE: I am the Owner of the Property where this event is to be held and I agree to comply with the laws, rules,regulations, conditions,and requirements of the Code of the Town of Southold,including but- not limited to the conditions listed below, as well as all other applicable agency rules and regulations pertaining to the activities under this event. Furthermore,I hereby swear or affirm that the information contained herein and attachments hereto are true and correct to the best of my knowledge, and agree to provide notice to the Town immediately should there be any material changes regarding to this application.. Furthermore,I hereby authorize Code Enforcement Personnel of the Town of Southold to enter the property during the hours of the permitted special event to make apf and all inspe 'ons necessaryin connection with this Special Event Print name of Owner Signature of Owner Print name of Authorized Person/Representative Signature of Authorized Person/Representative PERMISSION IS HEREBY GRANTED,SUBJECT TO THE FOLLOWING CONDITIONS: 1. By acceptance of this permit, applicant agrees to adequately supervise and direct all parking to be on the premises or at another site, and to provide parking assistants and any additional traffic controls necessary for this event.Parking is strictly prohibited on ANY Town, County or State Roads or Rights of Wav 2. Traffic control at events for three hundred(300) or more people shall be provided by a qualified traffic controller in accordance with the attached, approved traffic control plan. 3. One "on-premises" sign not larger than six (6) square feet in size may be displayed not longer than thirty (30) days before this event, and removed immediately after the event. Directional parking signs shall be adequately displayed. 4. Applicant indemnifies and holds harmless the Town of Southold from all claims, damages, expenses, suits and losses including but not limited to attorney's fees arising from activities under this permit. 5. Tent proposals must receive permit approval from the Southold Town Building Inspector before placement on the property and must meet all fire and safety codes. 6. This permit is valid only for the time, date, place and use specified above, and for the designated event. Each additional day will require a separate permit application, fee, and related documents for review,etc. at least 60 business days prior to the scheduled event. 7. Adequate temporary sanitary facilities must be provided by applicant for this event and applicant agrees to remove the temporary facilities from the premises within 48 hours after the day of the event. Updated 8/7/2018 he applicant/owner of the properly where the special event is proposed to take place must provide a certificate of insurance not less than 2 million dollars naming the Town of Southold as an additional ed A Parkin�/Event Plan: consisting of a survey, site plan and/or aerial view of the subject property that inc des the locations of on-site parking, sanitary facilities, and tents or other temporary structure(s). ,japplication application form for details) Even� for three hundred (300) or more people require submission and approval of a traffic control lan acceptable to the Town of Southold AND a qualified traffic controller must be provided at the et. (See application form for details) Signature of Property Owner on the application authorizing Code Enforcement Personnel of the Town of Southold to enter the subject premises during the hours of the event to ensure compliance with any and all special event permit conditions. My signature below affirms that I have submittedall the in rmation req 'red above in connection with my application. -Ill I in4A, �At----- Dated ignat Activities associated with outdoor public events are strictly prohibited from taking place on land preserved through the-sale of development rights to the Town of Southold, and can only take place on land preserved through the sale of development rights to the County of Suffolk with a permit issued by the Suffolk County Farmland Committee. If food is to be served, it must be catered and prepared off-site by food vendors who hold a permit to operate issued by the Suffolk County Bureau of Public Health Food Protection Unit. Updated 8/7/2018 8. On-site food preparation is NOT permitted, although food may be catered subject to all Suffolk County Department of Health regulations. 9'. NO-acti_vities_associated=with_this_e_veni i:ncluding_but_not_limited-to parking,-in rg ess/egress/access, tent(s)or temporary structure(s), or temporary sanitary facilities, shall be conducted on Town of Southold Purchase of Development Rights land. 10. NO activities associated with this event, including but not limited to parking, in rgress/egress/access. tents or temporary structure(s), or temporary sanitary facilities, shall be conducted on Suffolk County Purchase of Development Rights land without a permit issued by the Suffolk County Farmland Committee. 11.Issuance of this permit does not authorize in any manner the occupancy of any building exceeding the legal limitations under the fire code or other codes which would prohibit such increased occupancy. 12. Access shall be provided for emergency vehicles, to all public assembly areas, all buildings, all work areas and any additional area where emergencies may occur. Two emergency-fire exits and exit paths From the building(s) on the property, to a public way or remote safe area, shall remain open and unobstructed at all times. 13. Owner assures full compliance with all fire, safety,building,and other Town laws. 14. Music,when outdoors,is required to stop at the time specified in the permit.Placement of the speakers must be in a location that affords the greatest protection from noise intrusion upon adjacent properties. 15. Owner will allow access to Code Enforcement Personnel of the Town of Southold during the hours gfthe speciat event to make any and alt inspections necessary in connection with this Special Event. 16. ADDITIONAL CONDITIONS: ANY VIOLATIONS IN CONNECTION WITH THE CONDITIONS LISTED HEREIN WILL TERMINATE TINS PERMIT. APPROVED Town of Southold Resolution Number: Date Issued: Updated 8/7/2018 6/29/2022 r cft" ARY Fs a ESS s" ea s e I D� eor ARkl�6 i pAw+gfN�. OW 96k1r resr/ate I -_ --_. ® / h�.t � � VeJ��lps _P..�ti,..aYyre la�anc SCDHS Ref.*MO-0PO273 1 ® P",Pel UJ x75 SEP»C SYs7E1/ appX !!! / 'S' / 3 30 pudict sox lit,' r r WAS7.1EWNTS ® 6W—L- A' 2o,c 4cU [ .p. Wl°' 0 I C 40 1p 7s et nr wr 37 R.mlt� -fDU AlSU 12 U4R� m G ps rn I]El Lf Ox qv A YVEW, AICA.7740 mw TOWN OF.Ste.MySLATOW - -' 1 � C-01-A ALY. omits rDf>W - �roo.-sww_I %�/W(y�� I m • Y Y ma=iiFlm�i�.M[�m4vt rFr~ ! f M1f11 6f10ErJ lb-llp b '.40f1I1QL1 KI. 71111 I Ink Spot Printing & Copy Center 631.765.3625 info ail_.inkspotsouthold.com Iwww.inkspotsouthold.com 1 6 i� {f f i )r{ 1 7( i i 2/3 A CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 08/27/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT -Christmas Tree Dept NAME: Keelson Partners PHONE AIC N Exit: A1C(503)226-1422 FAX,No)- (503)226-2488 701 SIN Washington,Suite 625 E-MAL sdrvice@keelson.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Portland OR 97205-3536 INSURERA: Great Northern Insurance Co INSURED INSURER 8: - �'� #- �., f7 Dart's Christmas Tree Farm,DBA: INSURER C: Edward and Judy Dart ►NsuRERD: LI 2355 Main Bayview Rd INSURER E,_ - - COVERAGES CERTIFICATE NUMBER. 2021 GL REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR bublit POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MMIDD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 2,000,000 CLAIMS MADE ®OCCUR PREMISES Ea occuTErrence s 250,000 MED EXP(Any one person) S Excluded A Y 35766060 09/01/2021 09/01/2022 PERSONAL BADVINJURY s 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4,000,000 POLICY ❑JECT �LOC PRODUCTS-COMP/OPAGG S 4.000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) s OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE y AUTOS ONLY AUTOS ONLY. Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DEb RETENTibN S S WORKERS COMPENSATION I PER DTH- ANDEMPLOYERS'LIABWTY_ YIN STATUTE i ER ANY PROPRIETORIPARTNERIEXECUTIVE ❑ N/A E.L.EACH ACCIDENT s OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S If Yes,describe under --- —------- -- DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Addifional Remarks Schedule,maybe attached if mon:space is required) Certificate holder has been added as additional insured for operations of the named insured subject to policy terms,conditions,and exclusions with regard to location at 2355 Main Bayview Road,Southold,NY 11971 t/n � Vt , � CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEILIVERED IN —- - The Old-Town-Farm;I,LC—-- — - --- --ACCORDANCE WITH E-POLICYp-R.MaSIONS — ——- 2355 Main Bayview Road AUTHORIZED REPRESENTATIVE Southold NY 11971 �wvs�aa- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1 The (old. Town Farm ft'Ace 9?53 2355 Main Bayview.Rd Southold NY 11971 631- 369-1300 July 1, 2022 Southold Town Board Town Hall Southold,NY 11971 Supplemental Information for Special Event Application Saturday J�ry 21,2023 Family wishes to hold a Winter Wonderland themed private wedding at Dart's Christmas Tree Farm following the end of our Christmas tree season. This family is in the event business and will provide their own completely enclosed and heated solid wall temporary structure. All activities will be held indoors. Music, while indoors, is scheduled to end at l OPM.- Family will purchase decorative winter products from Dart's Christmas Tree Farm. All parking will be contained inside the property. Attendance anticipated at 250 people. Saturday August 26; 2423 Family wishes to hold a Summer on the Farm themed private wedding at Dart's Tree Farm. This will be a mostly outdoor tented event for approximately 130 people. Family will purchase our farm-grown flowers for use at their reception. Music is scheduled to end promptly at 1OPM. All parking will be onsite. Saturday September 1620-23 Family wishes to hold a Summer Harvest themed private wedding at the Old Town Farm. This will be a mostly outdoor tented event for not more than 250 people. Family will purchase our farm-grown flowers for use at their reception. Music is scheduled to end promptly at l OPM. All parking will be onsite. Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 07/02/22 Receipt#: 302729 Quantity Transactions Reference Subtotal 9 Event Fee 1 $150.00 Total Paid: $150.00 Notes: Payment Type Amount Paid By CK#4554 $150.00 Dart's, Tree Farm Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Dart's, Tree Farm 2355 Main Bayview Rd Southold, NY 11971 Clerk ID: DENISN Internal ID: 1